Western Medicine, a Means of Domination?

COMMENTARY - Last month, a Brazilian federal judge overruled the country’s 1999 law forbidding psychologists from offering treatment to ‘cure’ homosexual patients. This type of “conversion therapy” has been recognized by the United Nations Committee against Torture as a modern form of torture in 2014, yet continues to occur today. These proceedings prompt interrogations on the impact of modern western medicine on oppressed groups, and remind us of past medical discrimination and ill-treatment. 

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Physician demonstrating hysteria in a patient- Source: Wikimedia Commons

1)    Ancient Greece: Pathologized Femininity

The long and complex history of medical diagnosis being instrumental in subjugating women and minority groups begins with the “theory of the wandering womb”, whose origins can be traced back to ancient Greece. Presumably in the course of the 1st century CE, Aretaeus, a famous physician from Cappadocia, described the condition as such:

 

“In the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or the spleen, and it likewise is subject to prolapsus [falling down of an organ] downwards, and in a word, it is altogether erratic. It delights also in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.” [1]

 

The idea was that the uterus travelled within the female body, colliding with other organs and consequently causing vertigo, chocking, or a lack of strength. Women were accordingly understood to be slaves to their own biology. The medical diagnosis of hysteria itself stems from this belief, as illustrated by the very name given to the condition: hysteria from the Greek hystera, which translates in English to womb or uterus. In fact, any symptom specific to the female body could be attributed to a wandering uterus, and the cure was generally sexual intercourse, especially if it resulted in pregnancy, here reducing women to their reproductive power. Additionally, it was argued at the time that women would injure their wombs if they studied Greek or Mathematics –hence limiting their ambitions-, and biological differences were used to discredit when claims risking to destabilize the male hegemony were made.

This use of “scientific” explanations to normalize gender discrimination then repeated itself over and over throughout the years. Darwinian thinking was based around the idea that “man” has become superior to “woman” through natural selection. Herbert Spencer, a 19th century English philosopher, believed women were handicapped in their development because of the energy sacrificed to the reproductive process, and Geddes and Thompson theorized that male cells were active while female ones were passive. [2] All these outdates medical “discoveries” were intended to explain and justify women’s inferiority to men.

Today, wombs are not believed to wander anymore, and male/female cells are no longer understood as being inherently different, but medicine continues to pathologize aspects of the female reproductive system, as well as deviance from gender norms.

 

2)  The Victorian era: Hysteria and Asylums

Many scholars have over the years cultivated an interest for women’s nervous disorders (anorexia, nervosa, hysteria etc) and the ways in which they were constructed by science to reinforce social patriarchal values. In “Nervous Women: Sex Roles and Sick Roles”, Elaine Showalter argues that biological sexual differences were theorized to ensure women’s subordination and limit their ambition, especially in the course of the Victorian era, between the years 1830 to 1980. In this sense, any woman defying her “nature” (inspired by the Victorian model of femininity as fragile, selfless and nurturing) was considered mentally ill, especially if her productivity was affected. [3] Gender norms were hence placed at the center of a patient’s diagnosis, and used to determine who was mad or sane. The loss of womanly traits that ensured female productivity was perceived as problematic, as mad women were considered unfit for marriage and motherhood for not being self-sacrificing and nurturing. [4]

Men, on the other hand, were for long excluded from such diagnoses, as hysteria had purposefully been associated solely to women, rendering it difficult for doctors to associate an illness with such a strong feminine stigma to masculinity. [5] To prevent the public from recognizing the social construction of hysteria, men’s mental illnesses were either hidden, renamed (neurasthenia, which was essentially a form of hysteria for men), linked back to women (by blaming hereditary factors, for instance), or explained by denying the patient’s masculinity (the argument of homosexuality was often used here).

Mental illness was for long a tool for social control, and it was apprehended in a way that silenced and imposed control over the patient. At the time, the most common cure for these mental disorders affecting women was confinement. However, it has been argued that the role of asylums was more often to silence patients and conceal deviance than to guarantee their recovery. [6] Indeed, not only have 20th century scandals of sexual abuse or maltreatment regarding institutions of the sort surfaced, but the shock therapy (a psychiatric treatment of electrically induced seizures to provide relief from mental disorders) used to “cure” patients has also come to be perceived as a way to prevent “mad” women from changing their oppressed condition through delegitimization and physical numbing. [7]    

In 1892, Charlotte Perkins Gilman published “The Yellow Wallpaper”, a short work of fiction inspired by her struggle with depression and the medical institutions of her time. In 1887, she had sought treatment from the famous nerve specialist Dr. Silas Weir Mitchell, who championed the “rest cure”, in which women were immobilized in bed, prohibited from having intellectual or creative stimulation, and fed four ounces of milk every two hours. [8] In her writing, she describes the cure she underwent, and the formal prohibition of literature that was imposed on her. Gilman also discusses discrediting as a silencing method by virtue of her claims asylums treated hysteric women as selfish, irrational beings in need of supervision and deprived of physical or intellectual agency.   

3)   Today: Homosexuality and “Gender Dysphoria”

These aforementioned gender binaries have been influencing diagnoses and perspectives on illness because they have been presented as irrefutable facts: science has normalized them and given them legitimacy. The resulting strict social norms, however, do not only discriminate against women. As previously established, men suffering from mental disorders were also invalidated. Over the years, we are able to note a positive evolution in the treatment women with mental disorders receive, although it could be argued there are some remaining painful sequelae, as illustrated by the instant categorization as “crazy” or “hormonal” of a woman with too much anger or opinions. However, because these norms condemn gender deviance, LGBTQ* groups are nowadays the principle victims of these circumstances.    

To start with, the diagnosis of “homosexuality” was removed from the Diagnostic and Statistical Manual (DSM) – the handbook used by health professionals as a guide to the diagnosis of mental disorders- only in 1973. For long, homosexuality was viewed as a disease, “a condition deviating from ‘normal’, heterosexual development”. [9] In the 1950s, Psychiatrist Edmund Bergler wrote:

“I have no bias against homosexuals; for me they are sick people requiring medical help.” [10]  

Among the many types of medical solutions that were conceived to “cure” homosexual behavior were conversion therapies, which is a practice through which psychological intervention is used to attempt to change one’s sexual orientation. Some techniques include the administration of electric shock or nausea-inducing drugs during the presentation of same-sex images, psychoanalysis, or lobotomy. Conversion therapy has received considerable attention in the past few years, as international organizations like the United Nations have addressed the practice in the United Nations Committee Against Torture (CAT) [11], and many countries have started to take legal action. For instance, the government of Victoria in Australia introduced legislation banning conversion therapy in February 2016, and since 2010, no diagnosis can be made in the field of mental health on the basis of sexual orientation in Argentina. [12] Nonetheless, there are some examples of groups or states that continue to make use of these “reparative therapies”. Two noteworthy cases include Brazil’s 1999 law preventing psychologists from offering treatment for homosexuality, which was overruled by a federal judge last month, [13] and American evangelical groups who work toward spreading the anti-LGBTQ* practice overseas to countries on the African continent. [14]  

The trans communities are another example of a group whose human rights are breached daily by western medicine. Indeed, while homosexuality has been officially removed from the DSM and conversion therapies have been recognized as a form of modern torture by the United Nations, gender dysphoria or gender identity disorder (GID) still figure in the manual and are used to diagnose trans individuals with psychological disorders. The treatment for GID includes psychotherapy, or hormone therapy and surgery. Although many countries’ willingness to allow trans people to obtain full insurance coverage for the cost of their transformation is beneficial, the issue here is the obligation for a trans person to be diagnosed with a mental disorder to have access to sex reassignment therapy. Along these lines, the critic often put forth is that this classification of gender nonconformity as a mental disorder pathologizes gender variance and human diversity, reinforces gender binaries, and stigmatizes trans individuals. [15]     

 

4    Concluding remarks

Western medicine has therefore, since its existence, been used to reproduce patriarchal and heteronormative power relations. Through this, women’s and minority groups’ human right to life and freedom from torture have been violated, making aspects of the medical system disrespectful of human rights. Western medicine can thus be used as a means of domination, to perpetrate existing cleavages and maintain systems of hegemony, while violating some individual’s fundamental rights.

 

By Manon Fabre - Research Assistant at CIPADH

Bibliography

 

[1] Adams, Francis. 1856. Aretaeus, of Cappadocia. London: Printed for the Sydenham Society.

[2] Showalter, E. 1985. “Nervous Women: Sex Roles and Sick Roles” in The Female Malady: Women, Madness, and English Culture, 1830-1980. New York: Pantheon Books, 121-144.

 [3] IBID

[4] IBID

[5] Showalter, E. 1997. “Hysterical Men” in Hystories: Hysterical Epidemics and Modern Media. New York: Columbia University Press, 62-77.

[6] Chesler, P. 2005. “Asylums” in Women and Madness. New York: Palgrave Macmillan, 93-117.

[7] IBID

[8] Kapsalis, T. 2017. “Hysteria, Witches, and the Wandering Uterus: A Brief History”. LitHub.

[9] Drescher, J. 2015. “Out of the DSM: Depathologizing Homosexuality”.

[10] IBID

[11] Ethington-Boden, E. 2014. “UN condemns ‘conversion therapy’, but us right continues promoting in Africa”.

[12] Moret, G. 2016. “Gay Conversion therapy to be banned in Victoria”.

[13] The Guardian. 2017. “Brazilian judge approves ‘gay conversion therapy’, sparking national outrage”.

[14] Ethington-Boden. 2014.

[15] Lev, A. I. 2005. “Disordering Gender Identity: Gender Identity Disorder in the DSM-IV-TR”. Journal of Psychology and Human Sexuality, 35-69.

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